急性缺血性卒中Solitaire AB支架取栓术后颅内出血并发症分析

Analysis of intracranial cerebral hemorrhage in patients after receiving rescue thrombectomy with Solitaire AB stent for acute ischemic stroke

目的探讨急性缺血性卒中(AIS)患者接受Solitaire AB支架取栓术后颅内出血并发症的影响因素。方法收集2015年6月至2016年10月采用Solitaire AB支架取栓术治疗的32例AIS患者临床资料。分析取栓术后发生颅内出血性转化(HT)并发症患者基本资料,并与国内外相关研究进行对比分析。结果 32例AIS患者取栓手术均成功,术后病死率为9.4%(3/32)。3例术后发生症状性颅内HT,其中1例为前循环动脉闭塞,2例为后循环动脉闭塞,HT发生率为9.4%(3/32)。2例保守治疗,1例行经脑室钻孔外引流并植入储液囊,最终2例因HT死亡,1例经保守治疗恢复良好。HT死亡患者占所有死亡患者比例为2/3。结论颅内HT是AIS取栓手术致命性并发症。临床实践中应严格把握取栓手术适应证,术中精细操作,规范围术期管理,以降低出血并发症发生率。

Objective To discuss the influencing factors of intracranial cerebral hemorrhage complication in patients with acute ischemic stroke （AIS） after receiving Solitaire AB stent mechanical thrombectomy. Methods The clinical data of 32 AIS patients, who were treated with Solitaire AB stent thrombectomy during the period from June 2015 to October 2016 at authors＇ hospital, were retrospectively analyzed. The basic materials of patients, who developed intracranial hemorrhagic transformation （HT） after Solitaire AB stent thrombectomy, were analyzed and compared with the results of related studies published at home and abroad. Results Solitaire AB stent thrombectomy was successfully accomplished in all the 32 AIS patients. The postoperative fatality rate was 9.4% （3/32）. Three patients developed symptomatic intracranial HT after Solitaire AB stent thrombectomy, including artery occlusion in anterior circulation （n=l） and artery occlusion in posterior circulation （n=2）, with the HT incidence being 9.4% （3/32）. Of the 3 patients, conservative treatment was adopted in 2 and ventricular external drainage with implantation of liquid storage bag through ventricular drilling-hole was carried out in one. Finally, 2 patients died of HT and one patient recovered by conservative treatment. The percentage of HT death patients in all deaths was 66.7% （2/3）. Conclusion Intracranial HT is a fatal complication of embolectomy in AIS patients. In clinical practice, the indications of thrombectomy should be strictly observed, besides, intraoperative fine manipulation and sandardized perioperative management are also very important to reduce the incidence of bleeding complications. （J Intervent Radiol, 2017, 26： 390-393）